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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 2-©(5_C0 S–) 07 <br /> 0A, PO Box 66 <br /> !VO Crystal Bay, MN 55323-0066 Date received: <br /> Street Address:' Rpcei. Z I� <br /> 2750 Kelley Parkwa '1,pt� t <br /> �F c` Orono, MN 55356 Plan review fee: _54o; 3 <br /> �gkESHO�� Main: 952-259-4600 Total Fee: I„J R,,,,ouv, <br /> Fax: 952-249-4616 www.ci.orono.mn.us 1V� <br /> This application form must be completed in full and all required information must he submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: _ I [ ,( <br /> Job Site Address: <br /> _,)Ci L71 ;Ci .{'” I� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes _S�fVo <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> (;l <br /> Name: Avc vi , d <br /> State License# Expiration Date: <br /> Phone: cell office <br /> t` <br /> Mailing Address: Z�-I�-�j v ��,� - City: ~c I VCS ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNE INFO TION (. <br /> Name: I'G' <br /> Phone (day): 2 755 <br /> Address: City: OL021s ZIP: SSS <br /> Email and/or Fax rl (1QvU� 1 1iti`i .CiY�'1 <br /> ARCHITECT/ ENGLNEER IIZLFORNIATION: _ 11 <br /> Name: <br /> Phone (day): <br /> Address: Vv. it : li ZIP: <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑Accessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Office/Commercial <br /> ❑ Relocation L detached garage ❑ Residence ❑ Private Sewer <br /> her: (specify) I (Wr El Multiple Family/Condo E] Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> "Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> Packet Last Updated: January 2015 <br /> Page 20 <br />